INTRODUCTION The clinical management of chronic cough patients is challenging, and their response to proton pump inhibitors (PPIs) is considered as unsatisfactory. Few data concerning the association between impedance-pH variables and PPI response in these patients are available. Mean nocturnal baseline impedance (MNBI) and postreflux swallow-induced peristaltic wave (PSPW) index increase the diagnostic yield of impedance-pH in gastroesophageal reflux disease. METHODS Demographic, clinical, and endoscopy findings; impedance-pH; and high-resolution manometry tracings from consecutive patients assessed for cough were evaluated. Univariable and multivariable regression models were generated to evaluate the association between impedance-pH and high-resolution manometry findings, endoscopic and clinical characteristics, and PPI response. RESULTS A total of 178 patients were included. Eighty-four of 178 cough patients (47.2%) displayed grade C-D erosive esophagitis or were characterized by a pathological acid exposure time (AET) and/or positive symptom association probability/symptom index. When also considering MNBI and PSPW, 135 of 178 patients (75.8%) were characterized by the evidence of reflux disease (P < 0.001). Eighty patients (44.9%) had cough responding to PPIs, whereas 98 (55.1%) were nonresponders (P = 0.071). At the receiver operating characteristic analysis, both PSPW index and MNBI were associated to PPI responsiveness. MNBI and PSPW index showed higher sensitivity in predicting PPI response compared with AET and symptom association probability/symptom index. The area under the curves of MNBI and PSPW index were significantly higher than that of AET (P < 0.01 for both comparisons). When patients were stratified according to AET and excluding those with erosive esophagitis, pathological MNBI or PSPW index, hiatal hernia, and hypomotility features were associated to PPI response in all groups. DISCUSSION Our results demonstrate the usefulness of an up-front esophageal testing in discriminating reflux-related cough patients and predicting PPI response.

中文翻译：

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食管上段检测的结果可预测慢性咳嗽患者的质子泵抑制剂反应。

引言 慢性咳嗽患者的临床管理具有挑战性，他们对质子泵抑制剂 (PPI) 的反应被认为是不令人满意的。关于这些患者中阻抗-pH 变量与 PPI 反应之间关联的数据很少。平均夜间基线阻抗 (MNBI) 和反流后吞咽诱导的蠕动波 (PSPW) 指数增加了胃食管反流病中阻抗-pH 的诊断率。方法 人口统计学、临床和内窥镜检查结果；阻抗-pH值；评估了连续咳嗽患者的高分辨率测压图。生成单变量和多变量回归模型以评估阻抗-pH 与高分辨率测压结果、内窥镜和临床特征以及 PPI 反应之间的关联。结果 共纳入 178 名患者。178 名咳嗽患者中有 84 名 (47.2%) 表现出 CD 级糜烂性食管炎或以病理性酸暴露时间 (AET) 和/或阳性症状关联概率/症状指数为特征。当同时考虑 MNBI 和 PSPW 时，178 名患者中有 135 名 (75.8%) 具有反流病的证据 (P < 0.001)。80 名患者 (44.9%) 对 PPI 有咳嗽反应，而 98 名 (55.1%) 无反应 (P = 0.071)。在接受者操作特征分析中，PSPW 指数和 MNBI 都与 PPI 反应性相关。与 AET 和症状关联概率/症状指数相比，MNBI 和 PSPW 指数在预测 PPI 反应方面表现出更高的敏感性。MNBI和PSPW指数曲线下面积显着高于AET（P < 0. 01 两种比较）。当根据 AET 对患者进行分层并排除糜烂性食管炎患者时，病理 MNBI 或 PSPW 指数、食管裂孔疝和运动不足特征与所有组的 PPI 反应相关。讨论 我们的结果证明了前期食管检测在区分反流相关咳嗽患者和预测 PPI 反应方面的有用性。